Healthcare Provider Details

I. General information

NPI: 1154542108
Provider Name (Legal Business Name): CHAD H PRIESTLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE LOUIS A JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4199
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE LOUIS A JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4199
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-623-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number2125
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: